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Abstract：
BACKGROUND: Genitourinary tuberculosis (GUTB) is a common form of extrapulmonary TB (EPTB) in children. An example of GUTB is epididymal TB, which usually presents unspecific chronic clinical manifestations. Definitive diagnosis can be conducted based on bacteriologic confirmation and histopathologic results, but this is challenging due to the paucibacillary nature of EPTB. Therefore, we reported the challenges in diagnosing isolated epididymal TB in an adolescent male.
METHODS: A 16-year-old male presented to respirology clinic with painful swelling of the left scrotum for 3 months before visiting to the hospital. The symptoms were associated with persistent coughing for 2 months, and physical examination of the left scrotum showed swelling accompanied by cardinal signs. A palpable hard mass was found on the left scrotum, with firm borders, measuring 7 × 4 cm. Laboratory examination and tumor markers were within normal limits, although leukocyturia was found, and the urine culture was negative. Genital ultrasound (US) showed epididymitis sinistra with septal hydrocele, while magnetic resonance imaging (MRI) indicated inhomogeneous left epididymitis with bilateral inguinal lymph node enlargement. Although TB evaluation presented a negative purified protein derivative (PPD) test and bacteriologic examination, chest X-ray (CXR) showed perihilar lymphadenopathy. Based on the clinical and radiologic results suggesting TB, the patient was diagnosed with isolated epididymal TB and received quadruple antituberculosis therapy (ATT) for 6 months. After treatment, the left testicle size started to shrink and was equal to the right testicle, also, there were no signs of inflammation, the body weight increased by 5 kg, and cough disappeared. Sperm analysis at the end of treatment indicated teratozoospermia, which was subsequently treated by the urologic surgery department.
CONCLUSIONS: Biopsy and bacteriologic confirmation for TB epididymitis were challenging to perform in the clinical setting. Epididymal TB should be considered in adolescent males with complaints of chronic scrotal swelling and pain. Clinical judgment based on history taking, physical examination, and radiologic features supporting TB features could be helpful in accurate and fast diagnosis for favorable outcome.
METHODS: A 16-year-old male presented to respirology clinic with painful swelling of the left scrotum for 3 months before visiting to the hospital. The symptoms were associated with persistent coughing for 2 months, and physical examination of the left scrotum showed swelling accompanied by cardinal signs. A palpable hard mass was found on the left scrotum, with firm borders, measuring 7 × 4 cm. Laboratory examination and tumor markers were within normal limits, although leukocyturia was found, and the urine culture was negative. Genital ultrasound (US) showed epididymitis sinistra with septal hydrocele, while magnetic resonance imaging (MRI) indicated inhomogeneous left epididymitis with bilateral inguinal lymph node enlargement. Although TB evaluation presented a negative purified protein derivative (PPD) test and bacteriologic examination, chest X-ray (CXR) showed perihilar lymphadenopathy. Based on the clinical and radiologic results suggesting TB, the patient was diagnosed with isolated epididymal TB and received quadruple antituberculosis therapy (ATT) for 6 months. After treatment, the left testicle size started to shrink and was equal to the right testicle, also, there were no signs of inflammation, the body weight increased by 5 kg, and cough disappeared. Sperm analysis at the end of treatment indicated teratozoospermia, which was subsequently treated by the urologic surgery department.
CONCLUSIONS: Biopsy and bacteriologic confirmation for TB epididymitis were challenging to perform in the clinical setting. Epididymal TB should be considered in adolescent males with complaints of chronic scrotal swelling and pain. Clinical judgment based on history taking, physical examination, and radiologic features supporting TB features could be helpful in accurate and fast diagnosis for favorable outcome.
摘要：
背景：泌尿生殖道结核（GUTB）是儿童肺外结核（EPTB）的一种常见形式。GUTB的一个例子是附睾TB，通常表现为非特异性慢性临床表现。可根据细菌学确认和组织病理学结果进行明确诊断，但由于EPTB的低杆菌特性，这具有挑战性。因此,我们报道了一名青少年男性在诊断孤立性附睾结核方面的挑战.
方法：一名16岁男性就诊于呼吸科门诊，左阴囊疼痛肿胀3个月后就诊。症状与持续咳嗽2个月有关，左侧阴囊的体格检查显示肿胀并伴有体征。在左阴囊上发现了一个明显的硬肿块，有坚定的边界，测量7×4厘米。实验室检查和肿瘤标志物在正常范围内，尽管发现了白细胞增多症，尿培养呈阴性。生殖器超声（US）显示附睾炎伴间隔鞘膜积液，磁共振成像（MRI）提示左附睾炎不均匀伴双侧腹股沟淋巴结肿大。尽管结核病评估显示纯化蛋白衍生物（PPD）测试和细菌学检查呈阴性，胸部X线（CXR）显示肺门周围淋巴结肿大。根据临床和放射学结果提示结核病，患者被诊断为孤立性附睾结核,并接受四联抗结核治疗(ATT)6个月.治疗后,左睾丸大小开始缩小，等于右睾丸，还,没有炎症的迹象,体重增加了5公斤，咳嗽消失了.治疗结束时的精子分析显示畸形精子症，随后由泌尿外科治疗。
结论：结核性附睾炎的活检和细菌学确认在临床上具有挑战性。对于患有慢性阴囊肿胀和疼痛的青少年男性，应考虑附睾TB。基于病史的临床判断，体检,和支持TB特征的放射学特征可能有助于准确和快速诊断以获得有利的结果。
方法：一名16岁男性就诊于呼吸科门诊，左阴囊疼痛肿胀3个月后就诊。症状与持续咳嗽2个月有关，左侧阴囊的体格检查显示肿胀并伴有体征。在左阴囊上发现了一个明显的硬肿块，有坚定的边界，测量7×4厘米。实验室检查和肿瘤标志物在正常范围内，尽管发现了白细胞增多症，尿培养呈阴性。生殖器超声（US）显示附睾炎伴间隔鞘膜积液，磁共振成像（MRI）提示左附睾炎不均匀伴双侧腹股沟淋巴结肿大。尽管结核病评估显示纯化蛋白衍生物（PPD）测试和细菌学检查呈阴性，胸部X线（CXR）显示肺门周围淋巴结肿大。根据临床和放射学结果提示结核病，患者被诊断为孤立性附睾结核,并接受四联抗结核治疗(ATT)6个月.治疗后,左睾丸大小开始缩小，等于右睾丸，还,没有炎症的迹象,体重增加了5公斤，咳嗽消失了.治疗结束时的精子分析显示畸形精子症，随后由泌尿外科治疗。
结论：结核性附睾炎的活检和细菌学确认在临床上具有挑战性。对于患有慢性阴囊肿胀和疼痛的青少年男性，应考虑附睾TB。基于病史的临床判断，体检,和支持TB特征的放射学特征可能有助于准确和快速诊断以获得有利的结果。
